Provider First Line Business Practice Location Address:
RR 3 BOX 178B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVEYS LAKE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18618-9404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-639-1369
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2007